Otogenic multiple brain abscesses in infant in Kalimantan Timur: A case report

Abstract

Background: Otitis media (OM) is a common otologic condition in pediatric and adult populations. Brain abscess (BA) is commonly considered the second most common intracranial complication of OM after meningitis. It has been reported that 25% of BA in children were otogenic. Otogenic BA often manifests as a single lesion. A systematic review showed most otogenic BA was located in the temporal lobe (55%). Other includes the cerebellum (28%), frontal lobe, parietal lobe, subdural locations (5%), and not-specified (11%). Since multiple BAs due to otogenic infections are rarely reported, we are interested in reporting a case in our hospital in Kalimantan Timur.

Case presentation: A 4-month-old female infant was admitted with continuous high fever, generalized tonic-clonic convulsion, a progressive increase in head circumference, and bilateral transient downward eye deviation with a history of pus discharging from the left ear. Attic perforation was found on the left tympanic membrane. An emergency head computed tomography (CT) showed multiple rim-enhancing lesions with wide vasogenic edema on the right frontal region accompanied by a dilatation of the lateral, third, and fourth ventricles. A burr hole aspiration was done on the largest abscess and obtained 200 cc of pus that showed Methicillin-Resistant Staphylococcus aureus (MRSA) as a causative agent. Because of the findings, BA formation via hematogenous must be suspected. Several tests including blood culture, interferon (IFN)-gamma release assay, and echocardiography were performed. However, tests showed normal results.

Conclusion: Delay in diagnosis and treatment of otogenic infection may lead to multiple BA formations. Although the direct spread of otogenic infection occurs in multiple BA, suspicion of distant hematogenous spread should remain until proven otherwise.